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Experts frustrated by low HPV vaccination rates

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VCU CNS via Flickr Creative Commons

The federal government and several physicians associations Tuesday reiterated their support for vaccinating preteen boys and girls against a sexually transmitted infection that can cause cervical and other genital cancers. Meanwhile, experts in Southern California say providers' and parents' discomfort with the shot remains a major obstacle to improving chronically low vaccination rates.

The 2016 childhood and teen immunization schedule, published Tuesday on the Centers for Disease Control and Prevention website, calls for girls and boys to get three doses of a new version of the human papillomavirus (HPV) vaccine at age 11 or 12. The new version of the shot, approved in 2014, covers nine strains of HPV and protects against at least 80 percent of cervical, vulvar and anal cancers caused by HPV, according to the CDC.

The schedule, updated annually, is endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

The federal government has set a goal of having 80 percent of all boys and girls 13 to 15 years old obtain at least three doses of the HPV vaccine by 2020. But nationwide, vaccination rates remain far below that benchmark, a problem that was also highlighted by the President's Cancer Panel in its 2012-2013 report.

A 2014 CDC survey found that across the country, about 40 percent of 13- to 17-year-old girls and about 22 percent of 13- to 17-year-old boys had received three or more doses of the HPV vaccine. California did somewhat better: About 48 percent of girls in this age group and 31 percent of boys were estimated to have received three doses of the vaccine, although the margin of error was plus or minus 9.8 percentage points for the girls and plus or minus 8.9 percentage points for the boys.

The low HPV vaccination rates are due in part to providers' and parents' discomfort with a shot that prevents sexually transmitted infections, according to experts.

"It's really sad," says Dr. Roshan Bastani, director of the healthy and at-risk populations program at UCLA's Jonsson Comprehensive Cancer Center. "People are not getting the benefit of something that is really a wonderful breakthrough in the control of a very serious cancer."

UCLA is one of 69 National Cancer Institute-designated Cancer Centers that issued a joint statement last week describing the low HPV vaccination rates as a "serious public health threat" and calling for efforts to increase acceptance of the shot.

The suboptimal rates can also be attributed in part to the fact that "we haven't done ... a good enough job of educating primary care providers, particularly pediatricians, about this vaccine," says Dr. Richard Van Etten, director of the Chao Family Comprehensive Cancer Center at UC Irvine. His department also signed on to the Cancer Centers' statement.

In an effort to educate doctors, the California Department of Public Health offered providers a webinar on the HPV vaccine in January, according to a Department spokesman.

Some pediatricians are also uncomfortable with the vaccine's connection to sexual activity and "squirm a little" while talking about it, Bastani adds.

The vaccine's relationship with sex has made some parents hesitant as well, says Van Etten. Some believe that, because the HPV vaccine prevents a sexually transmitted infection, it could increase young people's sexual activity, he says, noting, "there's absolutely no evidence for that."

The new HPV vaccine now being recommended prevents the strains of the virus that cause genital warts in the short term and various cancers later on. Acknowledging people's discomfort discussing the shot's immediate benefits, Los Angeles County health officials are now talking more about the shot's long-term benefits, says Dr. Franklin Pratt, medical director for the L.A. County Department of Public Health's immunization program.

"We've moved it into the context of cancer prevention, which is really the important, long-term achievement here," Pratt says, adding, "that seems to be resonating with people."

The state Department of Public Health has worked with local health departments to develop HPV immunization information and materials for parents and preteens, says its spokesman, who adds that this information is utilized especially during Preteen Vaccine Week each February.

While restating its recommendation that HPV vaccination begin at age 11 or 12, the CDC's updated schedule now also says that children with a history of sexual abuse should receive their first dose of the vaccine at age 9.

The agency recommends that the second dose be administered at least one to two months after the first dose, and the third dose at least six months after the first one.

Young people who were not vaccinated as preteens or teens can catch up on the shot, the CDC says,  noting that the three-dose series is effective in males up to age 21 and in females through age 26.